Thank you, Speaker. If you’ll allow me, I would like to say thank you. I was supposed to do my lead on Thursday afternoon. I would like to thank my House leader team, as well as the House leader from the government, for allowing me to postpone my lead to this morning. I attended my nephew’s funeral Thursday afternoon. I was there when my nephew was born. My daughter used to babysit him and his brother. I was there when he graduated. He was a gifted mechanic, a really nice person. He died of a drug overdose at the age of 28, and it was gut-wrenching. I thank you for allowing me time to grieve with my family and attend his funeral. I will change the topic because I may start crying.

Thank you, also, to everybody who reached out and offered me a word of encouragement and support. From both sides of the House, I received them, and it was very much appreciated. Thank you.

Applause.

Home care has seen many changes in the way that it is governed and managed but not so many in the way that it is delivered. The way that it is managed is that there are basically three big groups of people who have needs and can live healthy and productive lives with the help of home care. We will start with the small one.

Some people are born with severe disability or diseases right from birth, whether they need special G-tube feeding to be able to feed themselves or they need help with breathing. Often, those babies becoming kids becoming grown-ups will be sent home with home care. For a lot of people who have severe disability and health needs—as I said, for breathing, for eating etc.—they could be on home care for their entire life. If you have a disability, you may tap into what is called the Passport Program, where you will basically become an employer and hire your own people to come and provide home care to you. Home care can range from helping you get out of bed and into your wheelchair in the morning, transferring to a toilet, showering, preparing meals, eating—all of the activities of daily living. So that’s one part.

The second part, which most adults will know, is post-discharge from hospitals—the ones that are the best known are hip and knee surgeries. I will take them as an example, but there are many others. For hip and knee surgeries, in my day, you used to be admitted to a hospital two or three days before and have the surgery. For a knee, you stayed for a week; for a hip, you stayed at least for 10 days—none of that anymore. All of the assessment is done ahead of time. They show you the exercises that you’ll have to do. They fit you for a walker or crutches, or whatever needs to be done. All of this is done before surgery. More and more, the surgery will be done the same day. The day of the surgery, you will be able to go home—or, at least, the next day or the following day. But the follow-up that used to happen in the hospital still needs to happen. You will have big surgical scars for which you will need a change of bandages. You will still need to be seen by a physiotherapist to make sure that you get your range of motion, you get your balance, you have full extension in your knees, you learn how to go up and down the stairs and how to manage on uneven ground—all of this. More and more of this in our home care is what we call bundled care; that is, you go home and you have a bundle of care where you already know that the nurse will come to see you on this day, this day and this day to change the bandages. The physiotherapist will come to see you to teach you exercises, then on day 5, she’ll start to teach you range of motion so that you get ready for stairs etc. etc. Bundled care happens after surgical or in-patient admission into the hospital.

The third part of home care—and I’m generalizing; there’s way more than that. The third part, I would say, is related to frailty and related to aging. Aging is not a disease. There are many, many elderly people who will live their entire lives never needing home care—but some of us will, and those are usually concentrated on what we call activities of daily living. So they may be able to get out of bed by themselves, but they will need help to go into a tub or a shower. They may be able to do certain things—they’ve had a stroke, and now they need a little bit of help to make sure that they learn to transfer from their bed to a wheelchair, or they learn to stand safely in their home, so you make their homes as safe as possible, to make sure that they continue to be able to walk, maybe with a walker, maybe with a cane, maybe with a quad cane etc.

This type of home care tends to go on for a longer period of time. You will continue to have somebody coming in to help you have a bath. You will continue to have people coming to see you to help you do the transfer, to help you do the toileting, to help you do the feeding and eating and preparing meals and changing the bedsheets and vacuuming. And if you live in my neck of the woods, you may need community care also to shovel the driveway. It just dumped snow in northern Ontario yesterday. The roads were really awful. By the way, where are all the snowplows? I did 450 kilometres, and I saw two snowplows going the opposite way, none in my way. The roads were awful.

Back to home care: So those are the three big parts of home care. Home and community care, way back, used to be delivered mainly by the VO; it was throughout the province. Saint Elizabeth was also very involved. We had the Red Cross. But VON was the biggest one. Basically, when you were discharged from hospital or when your family physician thought that it was not safe for you to be home by yourself, to have a bath by yourself or to transfer, they would send home care. There were no care coordinators or anything like this. It was a referral from your family physicians to home care, and home care was delivered to you. Home care was way closer to primary care at the time, because it was mainly your primary care provider who would make the referral for you to gain access to home care. All of this changed, Speaker, when the Mike Harris government came into power—I think you were there at the time, actually. When Mike Harris came into power, they decided to offer a competitive bidding process for home care rather than having this close-knit referral system from your primary care providers to not-for-profit home care providers that had been there for decades and decades.

In my neck of the woods, it was the VON who had the contract and who provided home care; they were the home care providers. They had nurses there who had done an entire career doing home care. They were really, really good at what they did. Just like anybody else—you work in one sector of health care, you develop best practices, you share them with the rest of your co-workers, and you get pretty good at providing that kind of care because this is what you do as a profession day in and day out.

All of this went out the window when the Mike Harris government decided to make home care “better, faster, cheaper” through the competitive bidding process. Through the competitive bidding process, we saw a whole lot of for-profit companies make bids to offer home care. The for-profit companies’ bids were amazing. They had found a way to clone Mother Teresa. They were going to offer incredibly good home care with knowledgeable people, and they were going to do things better, faster, cheaper. None of that happened—except that the not-for-profits did not win the bids. Most of the bids were won by the for-profit companies, and many not-for-profit home care providers that had been providing really good home care in close relationship to primary care were out of a job.

In my neck of the woods, everybody who used to work home care for VON were let go because VON did not win the contract; it was a for-profit American company that did, so everybody got laid off. The for-profit company tried to rehire some of them. They offered lower pay. They did not offer permanent jobs; they were all part-time. They offered no benefits, no pension, no sick days. And they changed the way they were going to be reimbursed—because in home care, you have to go from one home to the next. In northern Ontario, you drive long distances. In Toronto, you take transit to go from one place to the other. So the way they were going to be reimbursed went down.

What do you think happened to those nurses who had been working in home care all their lives? They said, “I’m not interested in working, standing by a phone”—because back then, it was not an app; it was a phone—“waiting for the phone to ring. I’m not interested in taking a cut in pay. I’m not interested in losing my pension plan. I used to like to have a couple of weeks of paid holidays, and I used to like to have a couple of paid sick days. Why should I do without all of this?” And they went and found work elsewhere. It’s not hard to find jobs when you have a nursing degree. Hospitals wanted them; primary care wanted them; palliative care wanted them—health promotion. It was really easy for them, and it started what we have now—where our home care system cannot recruit and retain a stable workforce.

Remember, I told you how home care was organized. At the end of the day, home care is a home care provider that comes to your home to help you. If you cannot recruit and retain home care providers to come to your home and help you, you cannot have quality home care.

So this is what we have been looking at in Ontario since 1996, when Mike Harris brought in the competitive bidding process, and it has been going downhill. It went downhill under the Liberals, and it’s going further downhill.

The contracts were first awarded by the province. Then, we had the creation of the CCACs, the community care access centres. CCACs would handle all of the home care. We had about 42 of them throughout the province. They were the ones that managed the contracts for home care. The physicians or nurse practitioners or primary care providers did not have direct contact with the home care providers anymore. Through the competitive bidding process, we put in place care coordinators. Care coordinators existed for one reason: to make sure that the limited amount of resources were going to be allocated as appropriately as possible. So we had a system where your family physicians or your nurse practitioners referred to the community care access centre—you couldd also self-refer—and then the care coordinators decide who of the different contractors, that got the different contracts, would provide you the care. We went from 42 community care access centres, CCACs, to 14 community care access centres, because by then, we had 14 LHINs, local health integration networks. The boundaries of the 42 community care access centres were reshaped to fit into the 14 LHINs’ boundaries. So we had 14 CCACs and 14 LHINs that managed the contracts for home care. They also had the care coordinators work for them. The care coordinators could decide how much care you would get. So we went from 42 to 14.

Then, the CCACs disappeared and they got kind of amalgamated with the local health integration networks. There continued to be 14 of them, but the CCACs did not exist anymore—the LHINs.

Then, from the LHINs, we had Home and Community Care Support Services, HCCSS—you learn a lot of alphabet when you work in that kind of program. Home and Community Care Support Services became the agency—14 of them—that would handle home care.

Now, under this new bill—because there have been many, many changes—Home and Community Care Support Services and the LHINs won’t exist anymore. It will be a new agency called Ontario Health atHome. Ontario Health atHome will be one agency province-wide that will then—the bill doesn’t say exactly how that will happen, but it will go into contractual arrangements with the 57 Ontario health teams that we have now in Ontario. If you’re lost in translation, don’t feel bad; we all are.

Ontario health teams are a creation of this government; we have 57 of them in Ontario. They cover almost, geographically—not quite the entire province. They’re all different, no matter where you go. All we know about Ontario health teams is that to be called a health team, you have to have at least three of those five—now six—providers. Hospitals can be a part, long-term-care homes can be a part, primary care can be a part, mental health and addictions can be a part, palliative care can be a part, and now home and community care can be a part. If three partners within those six types of partners in the health care system come together, they can be called an Ontario health team. Not everyone within those health teams are in, so it could very well be that—in my neck of the woods, the francophone community health centre does not want to be part of the family health team, and that’s fine. We still have a family health team that has a hospital—they have a few hospitals, actually: one in Sudbury and one in Espanola. There are a few long-term-care homes that are a part, though not all. There is, I think, one mental health provider that is in, and the rest of them are not. The family health teams went in, but the rest of the other primary care providers did not go in.

Anyway, if you have three of those six different areas of health that get together, you can be called a health team, and 57 health teams have been called throughout our province. But the health teams do not exist in and of themselves, as in, you won’t see them as a transfer payment agency on the list of agencies that the Auditor General reports on. They decide within themselves who will be the lead for the health team.

Well, let’s be serious. The health team that takes in a multi-million dollar hospital or a multi-million dollar long-term-care home—do you really think that a community health centre with a $2.7-million budget would ever be able to manage a health team? No. The big players are the ones who will manage the health teams.

The reluctance of many primary care, community mental health or community care providers to join those groups is that they feel it is hard to put women’s health at the top of the list—it is hard to put mental health; it is even harder to put addiction at the top of the list. Hospitals are well-known and people support them—not so much for other parts of our health care system. Now you’re asking those different health care providers to be within a health team that may not have them as a priority.

So the health teams vary greatly throughout the province. In some parts, they really had to be pushed hard—to say, “You must form a health team,” because the local health providers did not want to do that. As I said, they do not exist as an entity; they exist as a collaborative of good people who want to work together to improve care for the people of Ontario. Sometimes, in some areas, it works better than others—never mind how good or bad, this is where home care will go. It won’t go there initially. Home care should start to go to—I forgot if it’s 10 or 12, Ontario health teams that are a little bit more structured and have been in place a little longer, and they will be the ones that will start providing home and community care.

Those are the two big things that the bill does. It gets rid of the CCACs, LHINs, Home and Community Care Support Services—all of this disappears—and Ontario Health atHome becomes a province-wide agency that will be a sub-agency of Ontario Health. Ontario Health is already there to look after hospitals, long-term-care homes, primary care—a group of different players within the health care system. So Ontario Health atHome is being created; the LHINs and CCACs and Home and Community Care Support Services disappear. That’s one part.

Ontario Health atHome will have a board of directors. All that we know of the board of directors is that they will be appointed by the Ministry of Health. The board will consist of six members appointed by the ministry, and three members appointed by the minister—sorry, not the ministry; the minister—so six members appointed by the minister and up to three members appointed by the minister on the recommendations of Ontario Health.

You can see, Speaker, that the people who came and did deputations—very few of them were able to come and actually do a deputation, because under this government, it’s always the same thing: We have a meeting of the committee. They ask to go into closed session so nobody will know what they say, but they always say the same thing: “We will limit—here’s how many hours of deputations we will allow. It doesn’t matter if we have”—I don’t know if I’m allowed to say how many dozens and hundreds of people applied to do deputations. That doesn’t matter. There will be room for 15 or 18 people to do deputations—and that was it, that was all, on something like home care, that has needed reform for such a long time. Since the Mike Harris era of 1996, we have needed serious reform to improve the quality of our home care system. But no, we went in camera—I won’t tell you exactly what they said, because it was in camera, so I’m not allowed. But I can tell you that we came out of camera with a schedule that said there will be deputations from—